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Renal complications following heart transplantation in children: a single-center study
Véronique Phan1, Lori J West, Derek Stephens
1Depajtment of Paediatrics, Paediatric Academic MultiOrgan Transplant Program, The Hospital for Sick Children (HSC), University of Toronto, Toronto, M5G 1X8, Canada.
Insights
Pediatric heart transplant recipients often experience improved kidney function post-surgery. While acute renal dysfunction and hypertension are common initially, long-term outcomes for kidney function in these children are generally positive.
Area of Science:
- Pediatric Nephrology
- Pediatric Cardiology
- Transplantation Medicine
Background:
- Renal dysfunction is a frequent complication in adult heart transplant recipients.
- Limited data exists on renal function changes in pediatric heart transplant patients.
Purpose of the Study:
- To evaluate renal function and associated complications in children following heart transplantation.
- To assess the incidence and persistence of acute renal dysfunction and hypertension post-pediatric heart transplant.
Main Methods:
- Retrospective chart review of pediatric patients (<18 years) who underwent heart transplantation.
- Glomerular filtration rate (GFR) calculated using the Schwajtz formula; decreased GFR defined as <80 mL/min/1.73 m2.
- Statistical analysis of GFR changes over time using Repeated Measures Analysis of Variance.
Main Results:
- Of 41 eligible children, 42% had decreased GFR pre-transplant, improving to 7.3% at last follow-up (p=0.0001).
- GFR significantly increased in the first year post-transplant and remained stable thereafter (p=0.0002).
- Acute renal dysfunction occurred in 12/41 children; hypertension was diagnosed in 76% during the first year, persisting in 27%.
Conclusions:
- Pediatric heart transplantation is associated with significant improvement in renal function.
- Acute renal dysfunction and hypertension are common early post-transplant but often transient.
- Long-term renal function generally stabilizes or improves in children after heart transplantation.
Abstract:
Renal dysfunction is common following heajt transplantation (Tx) in adults, but little is known in children. Thus, a retrospective chajt review was performed in children who underwent heajt Tx at the Hospital for Sick Children between April 1994 and April 1999. The inclusion criteria were: age <18 years, survival >1 year post-Tx. The Schwajtz formula was used to calculate glomerular filtration rate (GFR). Decreased GFR was defined as <80 mL/min/1.73 m2. Changes in GFR were analyzed using Repeated Measures Analysis of Variance. Forty-one eligible children were included. The mean age at Tx was 7 years (range: 1 month to 16.7 years). The mean F/UP was 33 +/- 17 months, with 32/41 patients followed for at least 24 months. The GFR was decreased in 42% pre-Tx, and in 7.3% at the last F/UP (p = 0.0001). GFR did not decline significantly with time after Tx; in fact, GFR increased in the first year and remained stable afterwards (p = 0.0002). Acute renal dysfunction (ARD) episodes were common (12/41 children). Hypertension was diagnosed in 76% of children during the first year post-Tx, but persisted in only 11 (27%). GFR improves in the majority of children following heajt Tx. ARD episodes are frequent in the post-Tx period. Hypertension is common but does not persist.